Cited by 890Hormonal and reproductive studiesMenopause: Health Impacts and TreatmentsSexual function and dysfunction studies

Effects of Testosterone Treatment in Older Men

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Snyder, Peter J., Bhasin, Shalender, Cunningham, Glenn R., Matsumoto, Alvin M., Stephens-Shields, Alisa J., Cauley, Jane A., Gill, Thomas M., Barrett-Connor, Elizabeth +25 more·2016·New England Journal of Medicine

Abstract

BACKGROUND: Serum testosterone concentrations decrease as men age, but benefits of raising testosterone levels in older men have not been established. METHODS: We assigned 790 men 65 years of age or older with a serum testosterone concentration of less than 275 ng per deciliter and symptoms suggesting hypoandrogenism to receive either testosterone gel or placebo gel for 1 year. Each man participated in one or more of three trials--the Sexual Function Trial, the Physical Function Trial, and the Vitality Trial. The primary outcome of each of the individual trials was also evaluated in all participants. RESULTS: Testosterone treatment increased serum testosterone levels to the mid-normal range for men 19 to 40 years of age. The increase in testosterone levels was associated with significantly increased sexual activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased sexual desire and erectile function. The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003). Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy-Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo. The rates of adverse events were similar in the two groups. CONCLUSIONS: In symptomatic men 65 years of age or older, raising testosterone concentrations for 1 year from moderately low to the mid-normal range for men 19 to 40 years of age had a moderate benefit with respect to sexual function and some benefit with respect to mood and depressive symptoms but no benefit with respect to vitality or walking distance. The number of participants was too few to draw conclusions about the risks of testosterone treatment. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT00799617.).

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Crossref · 10.1056/nejmoa1506119

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  • There is accumulating evidence against a link between testosterone therapy and prostate cancer development.

    “there is accumulating evidence against a link between testosterone therapy and prostate cancer development.”

    From Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018) · cites this paper as [24]

    The Discussion reports four prostate cancer cases, three in men receiving testosterone, and explicitly says the sample was too small to assess the effect on prostate cancer risk reliably. The Conclusions likewise say there were too few participants to draw conclusions about treatment risks. The paper therefore does not present its findings as evidence against a link. (LLM, conf=0.86)

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  • In the Testosterone Trials, testosterone treatment improved 6-minute walk test results versus placebo (20.5% versus 12.6%; P=0.003).

    “In the ‘Testosterone Trials’, treatment with testosterone improved participants’ results in the 6 min walk test compared with placebo (20.5% versus 12.6%; P = 0.003)53.”

    From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [53]

    The Results > Efficacy section reports improved 6-minute walking outcomes with testosterone versus placebo among participants across all three Testosterone Trials, including P = 0.003 for the proportion whose walking distance increased by at least 50 m. Our copy does not give the cited 20.5% versus 12.6% figures. It also reports no significant difference for that outcome among participants in the Physical Function Trial alone. (LLM, conf=0.88)

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  • Randomized controlled trials have shown no significant increase in the rate of prostate cancer diagnosis in older, testosterone deficient men treated with testosterone compared to placebo.

    “Randomized controlled trials have shown that there is not a significant increase in the rate of a prostate cancer diagnosis in older, testosterone deficient men who were treated with testosterone compared to placebo.”

    From Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018) · cites this paper as [24]

    The Results (Adverse Events; page not available) report one prostate cancer diagnosis during treatment in the testosterone group, followed by two in that group and one in the placebo group during the subsequent year. The Discussion says the sample was too small to assess reliably whether testosterone affects prostate cancer risk. The paper therefore supports that few diagnoses occurred, but not the stronger claim that the trials established no significant increase in the diagnosis rate. (LLM, conf=0.86)

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  • In trials, patients with low testosterone have demonstrated statistically significant improvements in erectile function, sex drive, anemia, bone mineral density, lean body mass, and depressive symptoms.

    “In trials, patients with low testosterone have demonstrated statistically significant improvements in erectile function, 24 sex drive, 24 anemia, 25 bone mineral density, 26 lean body mass, 27 and depressive symptoms. 24”
  • Testosterone supplementation benefits other aspects of health, including sexual function, physical function, vitality, quality of life and improved mood.

    “Testosterone supplementation is also shown to benefit other aspects of health, including sexual function, physical function, vitality, quality of life and improved mood [109, 111].”

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Authors
Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., Gill, T. M., Barrett-Connor, E., Swerdloff, R. S., Wang, C., Ensrud, K. E., Lewis, C. E., Farrar, J. T., Cella, D., Rosen, R. C., Pahor, M., Crandall, J. P., Molitch, M. E., Cifelli, D., Dougar, D., Fluharty, L., Resnick, S. M., Storer, T. W., Anton, S., Basaria, S., Diem, S. J., Hou, X., Mohler, E. R., Parsons, J. K., Wenger, N. K., Zeldow, B., Landis, J. R., & Ellenberg, S. S.
Affiliations
  • University of Pennsylvania (US)
  • Brigham and Women's Hospital (US)
  • Baylor College of Medicine (US)
  • University of Washington (US)
  • From the Division of Endocrinology, Diabetes, and Metabolism (P.J.S.), the Department of Biostatistics and Epidemiology (A.J.S.-S., J.T.F., X.H., B.Z., J.R.L., S.S.E.), the Center for Clinical Epidemiology and Biostatistics (D. Cifelli, D.D., L.F.), and the Division of Cardiovascular Disease, Section of Vascular Medicine, Department of Medicine (E.R.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s...
  • University of Pittsburgh (US)
  • Yale University (US)
  • University of California San Diego (US)
  • The Lundquist Institute (US)
  • University of Minnesota (US)
  • Northwestern University (US)
  • New England Research Institutes (US)
  • University of Florida (US)
  • Albert Einstein College of Medicine (US)
  • National Institutes of Health (US)
  • Emory University (US)
Venue
New England Journal of Medicine
Published
2016-02-18
Volume
374
Issue
7
Pages
611-624
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2324158400
Cited by
890
References
40
Citations by year
2026: 49 · 2025: 73 · 2024: 73 · 2023: 97 · 2022: 79 · 2021: 65 · 2020: 81 · 2019: 76 · 2018: 103 · 2017: 106 · 2016: 86
FWCI
124.19
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5p60dk079626-05, UL1TR000142)
  • National Institute on Aging (U01AG030644, P30-AG013679, R01AG037679, K24AG021507, K07AG043587, R01 AG37679, P30AG024827, P30AG028740, P30AG021342)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK079626, P60-DK-079626, P30DK079626)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Keywords
testosterone replacement therapy, older men, hypogonadism, testosterone gel, sexual function, erectile function, sexual desire, physical function, walking distance, vitality, depressive symptoms, mood, adverse events
MeSH terms
Aged, Depression, Double-Blind Method, Fatigue, Humans, Libido, Male, Reference Values, Sexual Behavior, Testosterone, Walking, Prostate-Specific Antigen, Hormone Replacement Therapy

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